Healthcare Provider Details

I. General information

NPI: 1063543023
Provider Name (Legal Business Name): COLORADO GERIATRIC CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 12/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 W 26TH AVE SUITE C360
DENVER CO
80211-5308
US

IV. Provider business mailing address

PO BOX 40065
DENVER CO
80204-0065
US

V. Phone/Fax

Practice location:
  • Phone: 303-831-6686
  • Fax: 720-932-9255
Mailing address:
  • Phone: 303-831-6686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number41657
License Number StateCO

VIII. Authorized Official

Name: SONYA C KOHL
Title or Position: MANAGER
Credential:
Phone: 702-423-6894